Thursday, January 07, 2010

Bypass the Doctor and Go Straight to the Lab

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NEWSCHIEF -- While Washington is deep in the throes of trying to overhaul the nation's health-care system, another development is fast gathering momentum that shows the lawmakers in many ways are pursuing a moving target.

A growing number of Americans are bypassing doctors and going directly to online and storefront labs for diagnostic testing. Most often they pay for these tests out of their own pocket. The results may persuade the consumer to pursue the matter further with a personal physician but, in any case, the consumer is in charge of who sees the results.

The name of one fast-growing chain of walk-in labs encapsulates the field's business model, Any Lab Test Now. The company says it can generally have testing results within 24 hours and at a cost that is as much as 80% less than going through a doctor. The lab franchises offer up to 1,500 tests, from a simple cholesterol check to more sophisticated packages of tests that address complex medical issues.

The medical profession views this development with some skepticism, fearing that consumers will order the wrong kinds of tests or misdiagnose the results. Major physicians organizations like the American Medical Association have cautioned against any kind of clinical or genetic testing done without a doctor's consultation. There is no federal oversight over medical testing, other than requiring that the labs that do the actual testing for the storefronts be properly certified. State regulations vary widely. As so often happens, the consumers seem to be far out in front of the lawmakers and regulators.

36 Comments:

you realize that this is going to get whacked by congress, right? No way they don't add something to health care "reform" in the next 24 months that requires a Dr's order to have a medical test run and/or slaps wildly excessive taxes/licensing fees on these sort of places.

The medical profession views this development with some skepticism, fearing that consumers will order the wrong kinds of tests or misdiagnose the results.

If find this amusing. Even if I did order "the wrong kind of test" (not sure how that could be determined), how did it harm me to do an unnecessary test? As for diagnosis, couldn't I go to the local $50 clinic? I don't see how this is a problem.

Becuase it is totally anonymous, someone can take a test. When he finds out his condition is serious, he can just to buy health insurance and lies that he does not know he had such and such health condition. It implies higher health insurance premiums in the future.

1 The reason the tests are cheaper is that you give them your credit card, so they get paid now not in 2 months which is what it would take with insurance. 2. The Guild of physicians strikes again, our patients are to dumb to figure out what they need only we extremely wise people can tell them as we speak from our position as oracles. The US medical profession wants to protect people from themselves and from the evil pharmacist, since in Europe often the pharmacist can prescribe cold treatments and the like. Today there is a major disconnect between the training and the job responsibilities of most pharmacists, to much training to count pills, another health care Guild.

I'll admit that I've avoided lab tests for the last 5 years because I really don't look forward to the $660 doctor visit for a full physical examination that is usually the precursor to the complete blood work. On the other hand, one of my kids had pinkeye while on vacation last year so we went to a clinic in the back of Walgreens. The visit with a "real doctor" was only $69! Personal doctor visits are headed to the free market.

"Most will be a waste of money, or worse, provide misleading information.

Comparing results to a chart of standards can be massively misleading, especially out of any context (previous history, medications currently taken)."

We're pretty sure the patient knows his "context." It's his life/health history after all.

Besides, if a patient wants to "waste" his money... it's his money, isn't it?

Not sure that comparing test results to a chart will be "massively misleading." First of all, things like that have no mass. Secondly, if he's "misled" by the results, the worst that can happen is that he doesn't go to the doc. That's something he can do right now. Unless, of course, you want to make a doctor visit mandatory. (And, though you may be a paternalistic party pooper, we're sure you don't want that.)

Besides: It's not as if doctors never make errors. They do all the time.

I did a full blood panel with one of these outfits in Atlanta. (I was there on business... my home state wouldn't let the company do its dirty work in NJ... talk about paternalistic!) I found the information to be enlightening and handy. I'd do it again if I can make it over to Wyomissing!

Anon @ 1/8 2:22 has apparently been in a coma for some months now. The current health care bill would negate any need for anyone to lie to an insurance company about a pre-existing condition. The fear that premiums will rise is well founded, but not for the reason anon provides.

The real reason is the obama/reid/pelosi cabal that intends to deliberately kill the health insurance industry. You thin unemployment is high now? Wait until these morons are done destroying what's left of the economy.

This isn't necessarily "empowerment" for the patient. It is a clever way to get more tests than would be likely ordered by a provider, who will generally only order tests directed at the patient's current symptoms. The lab is taking advantage of people's ignorance to get them to agree to unnecessary testing to make money.

I diagnosed my own diabetes before going to a doctor, by noticing the symptoms and getting the urine strips at the local pharmacy. When I peed on the strip and it turned green (with frightening speed), I knew it was time to see the doctor.

Don't see what's wrong with this.

It would be nice to get my own HgA1c tests every quarter without going through my doctor and without paying an arm and a leg.

Why are so many people concerned about consumers ordering too many tests? Do you really expect laying down $49 for a test to become a hobby? This costs real money, not that theoretical money that the insurance company has after your deductible is met, and not the pre-tax money out of your HSA or MSA. If anything, I would expect people to be pickier since, so to speak, all the skin in the game is theirs.

It's my body, and therefore it's my data. It is an outrage that I have to get the permission of anyone to take a test and to get the results in private.

If General Motors built a car and said the only way you could read any of the computer diagnostic codes was to take it to a dealer who would read them in secret and you were forbidden to read them yourselves, all the Nanny State supporters who fancy themselves to be protectors of the consumer would squawk very loudly.

I am a physician (well, sort of, orthopaedic surgeon) and I love this. We need to empower patients, give more control to patients and more options and responsibility.We shouldn't be the gatekeepers, we should inform, give options and help patients make decisions for themselves.

I'm not sure if this is a good idea or not. On the one hand, more consumer power and choice is good. On the other hand this would be like herorin for hypochondriacs. I work in a hospital lab and I have a coworker (a clerk, not a lab tech) who when isn't coming into the ER for some inane reason is asking us to run tests on her because of some imaginary symptom she feels. One time she wanted me to check her cardiac enzymes! I can see her going nuts with this. On the other other hand, that doesn't necessarily mean that this shouldn't be availible as most peple are wiser than this. What might work is needing a script for the test and finding your own lab to do the testing.

Silly people, doctors can (and the smart ones do) beat this because doctors can contract for teting services in bulk and will always get lower prices.

Yes, you can get a CBC for $X but your doctor is ordering 40 of those a month. Do you really think he can't get a fraction of the price by contracting with a lab and charge less?

The real issue is that too many doctors' offices have an inefficient business model and too many nonessential staffers so prices go up to pay for all that extra payroll. What causes the inefficiency? Two things, lousy technology and excess government regulation.

Each patient should have the power to know what is going on, a lab test indicates that and takes power away from the doctors who never have time to talk to you. Besides isn't that why they have health fairs to test the populace for disease and now that you can get these tests without a doctor it now a problem...Clinical laboratory technologists/scientists have the knowledge to help people understand the basics of lab tests results but haven't empowered themselves to do so, so sad...

For example, I am very adept at diagnosing bladder infections. I'm better at it than my doctors. My doctors don't even question me anymore--if I say I or one of my children have a bladder infection they test and I am always right--even though our symptoms are asymptomatic.

But I can't prescribe myself or my children an antibiotic. So going to a lab to get tested wouldn't actually save me $$ because I would then have to go to a doctor to get the prescription anyway and now I would have made 2 trips instead of one.

Wouldn't many tests be this way?

I suppose an HIV test would be useful as someone mentioned, but a pregnancy test? I can get that down at my corner Walgreens just as easily.

I was directed here from another blog and just have to comment. I am a family doc for 25+ years. There is nothing inherently wrong with ordering your own tests but there are caveats.

Even with 7-11 years of post grad education and constant recertification we docs sometimes get it wrong. Do you honestly think you can do better with Wikipedia?

The danger is in delay of diagnosis for a significant condition. An above poster picked up his own diabetes and that is great. Could it have been found a year or two earlier if he/she had been getting routine exams? It makes a difference. (and it should not cast $600 for a routine physical).

The other thing that bothers me is that some outfits prey on peoples fears. At least once a month I will see a nervous patient who had a screening ultrasound of arteries for $100+, brought to you by a health fair, that is completely unnecessary, often inaccurate and requiring a follow on test to establish that the patient does not have a problem. This is real harm in terms of cost and needless worry on the patients part.

I am all for empowering the patient and helping them to make informed decisions, whether i think they are wise or not. But much if not most of modern medicine is too complex for DIY.

(for example, I see my doctor, don't diagnose myself or my family, listen to my doctor and do what he says.)

Something no one ever says about lab test results: "they are not perfect". There are many reasons a test result may not be of value. The easy one is glucose; if you eat before the test the result is falsely elevated because of the food you just ate. The lab test in your situation is a confirmation of your experience with the symptoms that have occurred in the past, so, if your body doesn't ever change you will always be correct.I hope this helps

Should you be required to go to a graphic designer every time you want to send out a Christmas photo card? Sure, we *could* let you do your own, but it would probably be ugly. Safer to pay me to do it for you. Or, well, I could write you a prescription to get somebody else to make you one. That's what professionals are for, you know. We have education and experience you can't simply grab off Wikipedia.

It's not like it's *your business* or anything. Aesthetics affect all of society; it's too dangerous to let you make these decisions yourself. Modern design is just too complex for DIY.

In fact we should probably have universal graphic design coverage, now that I think of it....

GregL, thank you for so clearly demonstrating what's wrong with our society.

"Isn't unnecessary testing by doctors claimed to be one cause of America's high %'age of GDP spent on health care? ... This just increases total health care expenditures with no increase in health care results."

Yes, if I pay for some test, that will increase expenditures. But who the hell's business is it what I do with my hard-earned money (what various levels of government graciously allow me to keep, that is)? If I have the right to literally burn my own money, I can bloody well use it to pay for some lab tests, however unnecessary they may be.

I think this is fantastic, except some of their prices are way too high. Perhaps there are some gullible consumers out there who don't know how much they should be paying.

For example, I pay $20 for my TSH through my insurance. This company is offering you a TSH, T3 and T4 (which are clinically useless to the average consumer) for $79.

No way I would ever pay that. Perhaps they figure that the patient is saving money on doctor copays so why not make them pay us instead of the doctor. Either way, the patient does not win with these prices.